Gordon H. Guyatt
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guyattgh.bsky.social
Gordon H. Guyatt
@guyattgh.bsky.social
85 followers 15 following 100 posts
Promoting use of the best evidence and patient values and preferences to inform optimal clinical and health policy decisions.
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guyattgh.bsky.social
I’ll be speaking at world’s best #EBM conference, 22nd to 24th October 2026, focus on EBM and AI . In #Taormina, renowned, picturesque hilltop town on #Sicily 's east coast, famous for its breathtaking views of the #IonianSea and active #MountEtna

www.ebhcconference.org/home.en-GB.h...
EBHC Conference | EBHC International Conference 2026 | Home
We are delighted to invite you to the 11th International Conference of Evidence-Based Health Care.
www.ebhcconference.org
February 8, 2026 at 10:09 AM
guyattgh.bsky.social
#CompositeEndpoints frequently mislead by overestimating benefits: #death, #MyocardialInfarction (dominated), and #revascularization. Worse, add #stroke to these three and goes in opposite direction to revascularization and composite favors the wrong intervention!

pubmed.ncbi.nlm.nih.gov/17573977/
Methodologic discussions for using and interpreting composite endpoints are limited, but still identify major concerns - PubMed
Methodologists have given limited attention to CEPs and their views are sometimes contradictory. Further work is needed to establish the role of CEPs in research and in guiding clinical practice.
pubmed.ncbi.nlm.nih.gov
February 8, 2026 at 10:09 AM
guyattgh.bsky.social
My favorite interview-based brief introduction to #EBM, the interviewer being my dear friend Jaeschke. Comment on the interview from the individual who organized ”It is well paced, illustrative and easy to follow – just the kind of conversation we were hoping for”

www.youtube.com/watch?v=I7ou...
All you need to know about EBM: A founder's guide to evidence, guidelines & getting back to the core
YouTube video by EBM One Platform
www.youtube.com
February 8, 2026 at 10:07 AM
guyattgh.bsky.social
#GRADE users frequently get confused about the appropriate – and inappropriate – use of good practice statements. This paper provides the needed #guidance.

pubmed.ncbi.nlm.nih.gov/27452192/
Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group - PubMed
Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group
pubmed.ncbi.nlm.nih.gov
February 2, 2026 at 11:33 AM
guyattgh.bsky.social
Latest asked question about Core #GRADE, essence of the GRADE approach to #evidence certainty and moving to #recommendations in #BMJ in 2025. Addresses when and how much to rate down for #imprecision. Joins GRADE for single study and a priori hypotheses explaining #heterogeneity

t.co/hh6owWxn5O
https://www.clarityresearch.ca/frequently-asked-questions
t.co
February 2, 2026 at 11:31 AM
guyattgh.bsky.social
Study of patients undergoing #NonCardiacSurgery (NCS) reports that 1 in 10 patients will have a covert (not clinically evident) #stroke. But consequences for subsequent function still uncertain – under investigation. Over 65, considering elective NCS, think twice.

pubmed.ncbi.nlm.nih.gov/27440630/
Covert stroke after non-cardiac surgery: a prospective cohort study - PubMed
NCT01369537.
pubmed.ncbi.nlm.nih.gov
February 2, 2026 at 11:29 AM
guyattgh.bsky.social
Just published key insight into #GRADE approach to #NMA. For assessing certainty of indirect #evidence GRADE relies on first order loop, ignores others. Maybe big problem, but review of 103 comparisons suggests almost no misleading conclusions. Hurrah for GRADE NMA!
pubmed.ncbi.nlm.nih.gov/41224137/
Influence of focusing on dominant first order loop when assessing the certainty of evidence of network meta-analysis: a case study - PubMed
NMA allows researchers to compare the relative effectiveness of multiple treatments. The GRADE working group provides guidance to establish the confidence in treatment effects (how likely they are to be true) by evaluating the COE to direct, indirect and NMA estimates, which can be high, moderate, l …
pubmed.ncbi.nlm.nih.gov
January 26, 2026 at 3:36 AM
guyattgh.bsky.social
5 minute conversation with brilliant and charming colleague @leticiakawano.bsky.social, recorded in lovely setting, #EBM perspective on decisions when #evidence is low certainty focusing on individual #patient values and how #physician input can be problematic.

www.youtube.com/watch?v=2SN6...
[English] Hormone Therapy for Menopause & Evidence-Based Medicine #EBM
YouTube video by RenovaMeta
www.youtube.com
January 26, 2026 at 3:35 AM
guyattgh.bsky.social
Old paper, remarkably relevant insights for assessing #DiagnosticTechnology: framework beginning range of possible uses, technologic capability, #DiagnosticAccuracy, impact on health care provider, #TherapeuticImpact, impact on #PRO and how to do each step.
pubmed.ncbi.nlm.nih.gov/3512062/
A framework for clinical evaluation of diagnostic technologies - PubMed
Most new diagnostic technologies have not been adequately assessed to determine whether their application improves health. Comprehensive evaluation of diagnostic technologies includes establishing technologic capability and determining the range of possible uses, diagnostic accuracy, impact on the h …
pubmed.ncbi.nlm.nih.gov
January 26, 2026 at 3:33 AM
guyattgh.bsky.social
Core #GRADE, 7 papers #BMJ 2025, all you need for GRADE addressing paired treatment comparisons. Question: Is Core really GRADE? Answer: Core undertook comprehensive review all prior GRADE writing, summarizes essentials. Core GRADE as GRADE gets! Details in 1 minute video.

vimeo.com/1151358052?f...
Is Core GRADE really GRADE?
This is "Is Core GRADE really GRADE?" by Clarity- McMaster on Vimeo, the home for high quality videos and the people who love them.
vimeo.com
January 19, 2026 at 2:41 AM
guyattgh.bsky.social
56 second summary of rationale for and essence of Core #GRADE I delivered at the 2025 Guidelines International (GIN) meeting.

vimeo.com/1151372251?f...
Core GRADE @ GIN 2025
This is "Core GRADE @ GIN 2025" by Clarity- McMaster on Vimeo, the home for high quality videos and the people who love them.
vimeo.com
January 19, 2026 at 2:41 AM
guyattgh.bsky.social
Model for conducting a search for #evidence regarding #patient #ValuesAndPreferences crucial for #guideline panels in moving from evidence to #recommendations. This one addressed #antithrombotic therapy and found 48 relevant studies.

pubmed.ncbi.nlm.nih.gov/22315262/
Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines - PubMed
Patient values and preferences regarding thromboprophylaxis treatment appear to be highly variable. Participant responses may depend on their prior experience with the treatments or health outcomes considered as well as on the methods used for preference elicitation. It should be standard for clinic …
pubmed.ncbi.nlm.nih.gov
January 16, 2026 at 5:24 AM
guyattgh.bsky.social
Just published exploration of US Medical Society #ClinicalPracticeGuideline over 5 years documented epidemic of discordant #recommendation meaning strong recommendations despite low certainty #evidence. Big problem needs addressing.

pubmed.ncbi.nlm.nih.gov/41428154/
Level of Evidence and Strength of Recommendations in US Medical Society Clinical Practice Guidelines, 2019-2023: A Cross-Sectional Analysis - PubMed
Among recently issued CPG recommendations, overall SOR-LOE rating concordance was moderate, although recommendations with strong SOR ratings had minimal rating concordance. CPG authors could provide clearer rationales for strong recommendations when the corresponding evidence does not reflect commen …
pubmed.ncbi.nlm.nih.gov
January 16, 2026 at 5:24 AM
guyattgh.bsky.social
Published in #BMJ, brilliant, startling exposition from Montori et al of our dystopic future as surveillance capitalism invades health care. Depicts how patients & clinicians are unable to know who is listening to their consultations, who is using their data & to what end
www.bmj.com/content/391/...
Reclaiming human care from surveillance capitalism
We must end the commodification of health data by big tech companies, centre healthcare on care, and put people back in control, argue Victor, J P, and Victor M Montori Big tech companies are drivin...
www.bmj.com
January 16, 2026 at 5:23 AM
guyattgh.bsky.social
Breakthrough interpreting #RCTs using patient-reported outcomes to measure treatment impact on patient function and #QualityofLife. In #BMJ instrument to measure credibility of estimates of #MinimallyImportantDifferences that allow estimation of magnitude of effect

pubmed.ncbi.nlm.nih.gov/32499297/
Evaluating the credibility of anchor based estimates of minimal important differences for patient reported outcomes: instrument development and reliability study - PubMed
Researchers, clinicians, and healthcare policy decision makers can consider using this instrument to evaluate the design, conduct, and analysis of studies estimating anchor based minimal important differences.
pubmed.ncbi.nlm.nih.gov
January 6, 2026 at 1:38 AM
guyattgh.bsky.social
Old photo, guess 2010, recently recovered. The four people responsible for the MAGIC evidence ecosystem foundation – Per Vandvik, Thomas Agoritsas, Linn Brandt and me, along with former Chair of my department for a decade, Brian Haynes, and current Chair Alfonso Iorio.

@thomasagoritsas.bsky.social
January 2, 2026 at 11:39 PM
guyattgh.bsky.social
#Clinicians don’t have the time or skills to read methods and results of original publications. They need to be able to interpret the #guidelines. So #EBM education must focus on certainty of evidence and how we get there, and understanding of summaries of results.

pubmed.ncbi.nlm.nih.gov/10753130/
Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch but all need some skills - PubMed
Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch but all need some skills
pubmed.ncbi.nlm.nih.gov
January 2, 2026 at 11:34 PM
guyattgh.bsky.social
Just published: What’s new in Core #GRADE? 7 papers in #BMJ spring 2025 summarize essentials of previous GRADE writings in an all-you-need format for applying GRADE. But also enhanced clarity and transparency and one spectacular innovation summarized here.
@bmj.com
pubmed.ncbi.nlm.nih.gov/41207400/
Core GRADE unpacked: a summary of recent innovations in complementary GRADE methodology - PubMed
The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework has become the global standard for rating evidence certainty and grading strength of health-care recommendations in systematic reviews, clinical practice guidelines (CPGs), and health technology assessments (HTAs …
pubmed.ncbi.nlm.nih.gov
January 2, 2026 at 11:32 PM
guyattgh.bsky.social
Term “Double Blind” worse than useless. #JAMA paper demonstrates that of the groups that could be blinded in #RCTs (patients, clinicians, data collectors, adjudicators), who is blind a mystery. Sadly, many RCTs still fail to make explicit.

pubmed.ncbi.nlm.nih.gov/11308438/
Physician interpretations and textbook definitions of blinding terminology in randomized controlled trials - PubMed
Our study suggests that both physicians and textbooks vary greatly in their interpretations and definitions of single, double, and triple blinding. Explicit statements about the blinding status of specific groups involved in RCTs should replace the current ambiguous terminology.
pubmed.ncbi.nlm.nih.gov
January 2, 2026 at 11:31 PM
guyattgh.bsky.social
This @jama.com paper demonstrates that of the groups that could be blinded in #RCTs (patients, #clinicians, data collectors, adjudicators, #statisticians) if a study says only “double-blind” one can’t tell who is blind. Sadly, many #RCTs still fail to make explicit.
pubmed.ncbi.nlm.nih.gov/11308438/
Physician interpretations and textbook definitions of blinding terminology in randomized controlled trials - PubMed
Our study suggests that both physicians and textbooks vary greatly in their interpretations and definitions of single, double, and triple blinding. Explicit statements about the blinding status of specific groups involved in RCTs should replace the current ambiguous terminology.
pubmed.ncbi.nlm.nih.gov
December 23, 2025 at 1:21 PM
guyattgh.bsky.social
Recent Cochrane collab Colombia Webinar: new #RiskofBias instrument for #RCTs, ROBUST-RCT @bmj.com publication this year. Talk shows how ROBUST-RCT maintains rigor while achieving user-friendliness and simplicity. Prediction: ROBUST will become the go-to #instrument.

www.youtube.com/watch?v=wFiS...
ROBUST-RCT: Risk of Bias instrument for use in Sys Tematic reviews for Randomised Controlled Trials
YouTube video by Teleducación Facultad de Medicina UdeA
www.youtube.com
December 23, 2025 at 1:19 PM
guyattgh.bsky.social
For anyone interested in the certainty/quality of evidence from studies of #Patient #ValuesAndPreferences, this #GRADE paper addressing #inconsistency, #imprecision and other domains is crucial.

pubmed.ncbi.nlm.nih.gov/29800687/
GRADE guidelines: 20. Assessing the certainty of evidence in the importance of outcomes or values and preferences-inconsistency, imprecision, and other domains - PubMed
We provide guidance and examples for rating inconsistency, imprecision, and other domains for a body of evidence describing the relative importance of outcomes.
pubmed.ncbi.nlm.nih.gov
December 17, 2025 at 3:26 PM
guyattgh.bsky.social
#RCT effects not normally distributed, follow a log-normal-Generalized Pareto Distribution. This doesn’t threaten underlying #equipoise, allows for discovery of large effects. Researchers conducting #Bayesian MA may consider using these priors.

pubmed.ncbi.nlm.nih.gov/41033405/
Theory of clinical therapeutic progress: reconciling equipoise with fat-tailed (skewed) outcomes - PubMed
Medical progress relies on research that ultimately must rest, in part, on experimentation in randomized controlled trials (RCTs) involving human subjects. Researchers are ethically required to protect trial patients from being knowingly exposed to inferior treatments. This is achieved by requiring …
pubmed.ncbi.nlm.nih.gov
December 17, 2025 at 3:24 PM
guyattgh.bsky.social
Just published big news for #IntensiveCare. #RandomizedTrial demonstrates that a #ProtonPumpInhibitor not only decreases gastrointestinal #bleeding, but because of #costs generated by those bleeds also appreciably decreases #ICU costs.

jamanetwork.com/journals/jam...
Cost-Effectiveness of Pantoprazole for Upper GI Bleeding During Ventilation
This economic evaluation examines cost-effectiveness of daily intravenous pantoprazole vs no pantoprazole for preventing upper gastrointestinal bleeding in critically ill, mechanically ventilated pati...
jamanetwork.com
December 15, 2025 at 1:58 AM
guyattgh.bsky.social
Gigantic #GRADE breakthrough in 2017: we rate certainty in whether a treatment effect lies on one side of a threshold or the other. But much clearer detailed guidance on choosing the target of the certainty rating was still needed. This article provides the guidance
pubmed.ncbi.nlm.nih.gov/33857619/
GRADE guidelines 32: GRADE offers guidance on choosing targets of GRADE certainty of evidence ratings - PubMed
GRADE provides practical principles to help systematic review and health technology assessment authors specify the target of their certainty of evidence rating.
pubmed.ncbi.nlm.nih.gov
December 15, 2025 at 1:57 AM